Obstetric perineal wound infection: is there underreporting?

Abstract

Obstetric perineal wound infection is a complication of perineal trauma during vaginal delivery; however, it is difficult to establish its true incidence as women present for treatment to their GP or the hospital.

Aim: To establish the incidence and risk factors of wound infection in postpartum women with sutured tears.

Method: A 3-month prospective audit was carried out on all women who sustained sutured tears. Wound infection was defined as the presence of any two of the following markers: perineal pain, wound dehiscence, or purulent vaginal discharge. A total of 341 women were contacted by telephone 21 days post-delivery and asked about markers for perineal wound infection and antibiotic use.

Results: In total, 409 women sustained sutured perineal tears, including episiotomies, and first, second, third and fourth degree tears. Of the 341 (83%) women contacted, 39 (11%) had a perineal wound infection based on the criteria of any two infection markers. Sixteen(5%) women had all three markers of wound infection. Prolonged rupture of membranes and instrumental delivery was a significant risk factor for women with two and three markers of wound infection,respectively.

Conclusion: One in ten women who sustained a perineal tear at vaginal delivery that required suturing developed perineal wound infection. Instrumental deliveries and prolonged rupture of membranes predispose women to perineal wound infection.